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Calciphylaxis — RACP Adult Medicine MCQ

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HardNephrologyCalciphylaxisRACP Adult Medicine

A 72-year-old woman with CKD stage 5 on haemodialysis develops intractable vomiting and abdominal pain. Her serum calcium is 3.8 mmol/L and phosphate is 3.2 mmol/L. She has extensive soft tissue calcification on X-rays (calciphylaxis). Her PTH is 1,200 pg/mL. What is calciphylaxis?

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Correct answer: E — Metastatic calcification of tendons only

Calciphylaxis (calcific uraemic arteriolopathy) is a rare but devastating complication of CKD/ESKD characterised by calcification of small arteriolar media causing vessel occlusion, ischaemic skin necrosis, and extremely painful ulcerations (typically on thighs, abdomen, and buttocks). Mortality is 60–80%. Risk factors include hyperparathyroidism, hyperphosphataemia, hypercalcaemia, warfarin use, and obesity. Treatment includes wound care, sodium thiosulfate (IV – decalcifying agent), intensified dialysis, phosphate binders (non-calcium based), cinacalcet, and parathyroidectomy for refractory hyperparathyroidism. Warfarin should be ceased.

Reference: KHA-CARI – 2013 – CKD-MBD; KDIGO – 2017 – CKD-MBD Update